A 25-year-old healthy woman was admitted to our hospital with fever and abdominal pain. Abdominal contrast-enhanced computed tomography revealed a fluid collection with foamy gas formation extending from both rectus abdominis muscles to the subcutaneous tissue. Antimicrobial therapy with meropenem (3 g/day), clindamycin (1800 mg/day), and daptomycin (300 mg/day) was initiated as empiric therapy. Subcutaneous abscess culture revealed gram-positive cocci, which was identified as Anaerococcus tetradius. Histopathological examination of the necrotic tissue showed skeletal muscle necrosis. On the basis of these findings, the patient was diagnosed with Non-Clostridial Gas Gangrene (NCGG) due to A. tetradius. We report a novel case of NCGG caused by A. tetradius following a cesarean section in an immunocompetent patient. Although A. tetradius has been detected in clinical specimens, cases of human infections are extremely rare. Clinicians should consider A. tetradius infection as a complication of a cesarean section.
{"title":"Non-clostridial gas gangrene due to Anaerococcus tetradius following a cesarean section: A case report","authors":"Takehiro Hashimoto , Mamiko Okamoto , Tomonori Yamada , Eiji Kobayashi , Kazufumi Hiramatsu","doi":"10.1016/j.bjid.2025.104609","DOIUrl":"10.1016/j.bjid.2025.104609","url":null,"abstract":"<div><div>A 25-year-old healthy woman was admitted to our hospital with fever and abdominal pain. Abdominal contrast-enhanced computed tomography revealed a fluid collection with foamy gas formation extending from both rectus abdominis muscles to the subcutaneous tissue. Antimicrobial therapy with meropenem (3 g/day), clindamycin (1800 mg/day), and daptomycin (300 mg/day) was initiated as empiric therapy. Subcutaneous abscess culture revealed gram-positive cocci, which was identified as <em>Anaerococcus tetradius</em>. Histopathological examination of the necrotic tissue showed skeletal muscle necrosis. On the basis of these findings, the patient was diagnosed with Non-Clostridial Gas Gangrene (NCGG) due to <em>A. tetradius</em>. We report a novel case of NCGG caused by <em>A. tetradius</em> following a cesarean section in an immunocompetent patient. Although <em>A. tetradius</em> has been detected in clinical specimens, cases of human infections are extremely rare. Clinicians should consider <em>A. tetradius</em> infection as a complication of a cesarean section.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 1","pages":"Article 104609"},"PeriodicalIF":2.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1016/j.bjid.2025.104603
Adriana Neis Stamm , Cristiane Valle Tovo , Andressa Noal , Camila Ubirajara Silva , Jaysa Pizzi , Pedro Moreno Fonseca , Dimas Alexandre Kliemann
Background
Chronic Hepatitis B Virus (HBV) infection remains a major global health burden, affecting approximately 296 million individuals worldwide and leading to significant morbidity and mortality due to cirrhosis and Hepatocellular Carcinoma (HCC). Although Nucleos(t)ide Analogues (NAs) such as Tenofovir Disoproxil Fumarate (TDF) and Entecavir (ETV) effectively suppress HBV replication, their comparative efficacy in reducing HCC risk remains controversial.
Methods
This retrospective cohort study analyzed HBV-monoinfected patients treated with either TDF or ETV at a tertiary hospital in southern Brazil between 2014 and 2021. Patients with co-infections (HIV, HCV), prior HCC diagnosis, liver transplantation, or others antiviral treatments, like lamivudine e/ou alfainterferon, were excluded. Data on demographics, treatment regimens, disease progression, and HCC incidence were extracted from institutional databases. Statistical analyses included Fisher's exact test and Poisson regression to determine Relative Risk (RR) and 95 % Confidence Intervals (95 % CIs).
Results
Of the 127 included patients, 66 (52 %) received TDF and 61 (48 %) received ETV. Over a 7-year follow-up period, 10 patients developed HCC – 8 in the ETV group (13.1 %) and 2 in the TDF group (3 %). In the raw analysis, TDF use was associated with a significantly lower risk of HCC progression (RR = 0.23, p = 0.057, 95 % CI: 0.05‒1.046). After adjusting for the variable’s cirrhosis/advanced fibrosis and age in the multivariate analysis, this association lost statistical significance (RR = 0.33, p = 0.18, 95 % CI: 0.068‒1.685). This indicates that the apparent protective effect of tenofovir may have been influenced by these variables and may have limited the statistical power of the adjusted model. Patients receiving ETV had a higher prevalence of advanced liver disease, including cirrhosis (64.7 % vs. 35.3 %, p < 0.05), hepatic encephalopathy (7 % vs. 2.4 %, p < 0.05), and portal hypertension (12.5 % vs. 3.4 %, p < 0.05). The incidence rate of HCC was 1.12 per 100 person-years (to be interpreted with caution due to limited follow-up data).
Conclusion
Treatment with TDF was associated with a lower risk of HCC compared to ETV in the bivariate analysis, but this association lost significance in the multivariate analysis. These findings suggest that the initially observed protective effect of TDF against hepatic carcinogenesis may have been partially explained by confounding factors (cirrhosis/advanced fibrosis and age), as well as reflecting the limited sample size. Further studies are warranted to provide a more robust comparative evaluation of antiviral therapies.
{"title":"Tenofovir vs. entecavir in chronic hepatitis B: A retrospective cohort study of hepatocellular carcinoma risk in a tertiary hospital in southern Brazil","authors":"Adriana Neis Stamm , Cristiane Valle Tovo , Andressa Noal , Camila Ubirajara Silva , Jaysa Pizzi , Pedro Moreno Fonseca , Dimas Alexandre Kliemann","doi":"10.1016/j.bjid.2025.104603","DOIUrl":"10.1016/j.bjid.2025.104603","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Hepatitis B Virus (HBV) infection remains a major global health burden, affecting approximately 296 million individuals worldwide and leading to significant morbidity and mortality due to cirrhosis and Hepatocellular Carcinoma (HCC). Although Nucleos(t)ide Analogues (NAs) such as Tenofovir Disoproxil Fumarate (TDF) and Entecavir (ETV) effectively suppress HBV replication, their comparative efficacy in reducing HCC risk remains controversial.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed HBV-monoinfected patients treated with either TDF or ETV at a tertiary hospital in southern Brazil between 2014 and 2021. Patients with co-infections (HIV, HCV), prior HCC diagnosis, liver transplantation, or others antiviral treatments, like lamivudine e/ou alfainterferon, were excluded. Data on demographics, treatment regimens, disease progression, and HCC incidence were extracted from institutional databases. Statistical analyses included Fisher's exact test and Poisson regression to determine Relative Risk (RR) and 95 % Confidence Intervals (95 % CIs).</div></div><div><h3>Results</h3><div>Of the 127 included patients, 66 (52 %) received TDF and 61 (48 %) received ETV. Over a 7-year follow-up period, 10 patients developed HCC – 8 in the ETV group (13.1 %) and 2 in the TDF group (3 %). In the raw analysis, TDF use was associated with a significantly lower risk of HCC progression (RR = 0.23, <em>p</em> = 0.057, 95 % CI: 0.05‒1.046). After adjusting for the variable’s cirrhosis/advanced fibrosis and age in the multivariate analysis, this association lost statistical significance (RR = 0.33, <em>p</em> = 0.18, 95 % CI: 0.068‒1.685). This indicates that the apparent protective effect of tenofovir may have been influenced by these variables and may have limited the statistical power of the adjusted model. Patients receiving ETV had a higher prevalence of advanced liver disease, including cirrhosis (64.7 % vs. 35.3 %, <em>p</em> < 0.05), hepatic encephalopathy (7 % vs. 2.4 %, <em>p</em> < 0.05), and portal hypertension (12.5 % vs. 3.4 %, <em>p</em> < 0.05). The incidence rate of HCC was 1.12 per 100 person-years (to be interpreted with caution due to limited follow-up data).</div></div><div><h3>Conclusion</h3><div>Treatment with TDF was associated with a lower risk of HCC compared to ETV in the bivariate analysis, but this association lost significance in the multivariate analysis. These findings suggest that the initially observed protective effect of TDF against hepatic carcinogenesis may have been partially explained by confounding factors (cirrhosis/advanced fibrosis and age), as well as reflecting the limited sample size. Further studies are warranted to provide a more robust comparative evaluation of antiviral therapies.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 1","pages":"Article 104603"},"PeriodicalIF":2.8,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.bjid.2025.104605
Pierre Danneels , Floris Chabrun , Lucia Grandière-Pérez , Ali Touré , Vincent Dubée
Objectives
NOVA and DENOVA scores were developed to guide endocarditis risk assessment in Enterococcus faecalis Bacteremia (EfB), but some of their criteria may be open to interpretation. We aimed to evaluate their inter-rater reliability and feasibility.
Methods
Thirty-two physicians from four specialties involved in the management of endocarditis independently evaluated eight EfB patient records using the NOVA and DENOVA scores. Each score was applied eight times per case. Inter-rater reliability was measured with Krippendorff’s alpha, and agreement with Fleiss’ Kappa. Completion time was also recorded.
Results
No record received identical scores from all raters. NOVA showed low inter-rater reliability (α = 0.37), while DENOVA reached moderate levels (α = 0.49). High agreement was found for extreme score values, but agreement dropped markedly for intermediate values. Among score items, Auscultation of murmur (A) and Valve disease (V) had the highest reliability (α > 0.8), while Duration of symptoms (D) and Origin of infection (O) had the lowest (α < 0.2). Completion times were similar between NOVA and DENOVA but varied by specialty.
Conclusion
The reproducibility of these scores is limited, especially near critical thresholds, highlighting the need to complement scoring tools with clinical judgment in EfB.
{"title":"Endocarditis risk stratification with scores: what about reproducibility? The case of NOVA and DENOVA scores for Enterococcus faecalis bacteremia","authors":"Pierre Danneels , Floris Chabrun , Lucia Grandière-Pérez , Ali Touré , Vincent Dubée","doi":"10.1016/j.bjid.2025.104605","DOIUrl":"10.1016/j.bjid.2025.104605","url":null,"abstract":"<div><h3>Objectives</h3><div>NOVA and DENOVA scores were developed to guide endocarditis risk assessment in <em>Enterococcus faecalis</em> Bacteremia (EfB), but some of their criteria may be open to interpretation. We aimed to evaluate their inter-rater reliability and feasibility.</div></div><div><h3>Methods</h3><div>Thirty-two physicians from four specialties involved in the management of endocarditis independently evaluated eight EfB patient records using the NOVA and DENOVA scores. Each score was applied eight times per case. Inter-rater reliability was measured with Krippendorff’s alpha, and agreement with Fleiss’ Kappa. Completion time was also recorded.</div></div><div><h3>Results</h3><div>No record received identical scores from all raters. NOVA showed low inter-rater reliability (α = 0.37), while DENOVA reached moderate levels (α = 0.49). High agreement was found for extreme score values, but agreement dropped markedly for intermediate values. Among score items, Auscultation of murmur (A) and Valve disease (V) had the highest reliability (α > 0.8), while Duration of symptoms (D) and Origin of infection (O) had the lowest (α < 0.2). Completion times were similar between NOVA and DENOVA but varied by specialty.</div></div><div><h3>Conclusion</h3><div>The reproducibility of these scores is limited, especially near critical thresholds, highlighting the need to complement scoring tools with clinical judgment in EfB.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 1","pages":"Article 104605"},"PeriodicalIF":2.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.bjid.2025.104592
Rodrigo Guimarães Cunha , Elba Regina Sampaio de Lemos , Luiz de Melo Amorim Filho , Maria Esther Duarte Lopes , Marco Aurelio Pereira Horta , Renata Carvalho de Oliveira
The transfusion of blood components is a critical therapeutic intervention for certain clinical conditions for which alternative treatments are often unavailable. Despite the benefits, transfusions can pose health risks to the recipients, including potential transmission of infectious agents. Post-donation, blood components undergo testing for major transmissible agents such as Human Immunodeficiency Virus (HIV), Hepatitis B and C Viruses (HBV and HCV), Treponema pallidum (syphilis), and Trypanosoma cruzi (Chagas disease). This retrospective study assessed the prevalence of donor unsuitability due to these agents and examined potential influences on the profile of blood-borne infections among healthy blood donors in the region. This study was conducted at a public institution in Brazil from January 2014 to December 2021. All effective blood donations were included, totaling 600,001. The donor demographic profile was as follows: 60.5% male, 52.2% single, 44.5% self-identified as white, 39.6% completed high school, and the 31–40 year age group had the highest number of donors, comprising 28%, with the majority being regular donors (70.4%). The prevalence of hemotransmissible agents was 2.13% (T. pallidum), 1.54% (HBV), 0.44% (HIV), 0.36% (T. cruzi), 0.26% (HCV), and 0.23% (HTLV). Specific associations were noted among the sociodemographic data for each condition. T. pallidum and HBV infections are the most frequent causes of donor ineligibility. The data indicate that prevalence rates remained relatively constant with minor fluctuations throughout the study period, although the frequency of HIV infection was notably higher in 2021.
{"title":"Blood safety and epidemiological trends of blood-borne infections in Brazil: A retrospective analysis","authors":"Rodrigo Guimarães Cunha , Elba Regina Sampaio de Lemos , Luiz de Melo Amorim Filho , Maria Esther Duarte Lopes , Marco Aurelio Pereira Horta , Renata Carvalho de Oliveira","doi":"10.1016/j.bjid.2025.104592","DOIUrl":"10.1016/j.bjid.2025.104592","url":null,"abstract":"<div><div>The transfusion of blood components is a critical therapeutic intervention for certain clinical conditions for which alternative treatments are often unavailable. Despite the benefits, transfusions can pose health risks to the recipients, including potential transmission of infectious agents. Post-donation, blood components undergo testing for major transmissible agents such as Human Immunodeficiency Virus (HIV), Hepatitis B and C Viruses (HBV and HCV), <em>Treponema pallidum</em> (syphilis), and <em>Trypanosoma cruzi</em> (Chagas disease). This retrospective study assessed the prevalence of donor unsuitability due to these agents and examined potential influences on the profile of blood-borne infections among healthy blood donors in the region. This study was conducted at a public institution in Brazil from January 2014 to December 2021. All effective blood donations were included, totaling 600,001. The donor demographic profile was as follows: 60.5% male, 52.2% single, 44.5% self-identified as white, 39.6% completed high school, and the 31–40 year age group had the highest number of donors, comprising 28%, with the majority being regular donors (70.4%). The prevalence of hemotransmissible agents was 2.13% (<em>T. pallidum</em>), 1.54% (HBV), 0.44% (HIV), 0.36% (<em>T. cruzi</em>), 0.26% (HCV), and 0.23% (HTLV). Specific associations were noted among the sociodemographic data for each condition. <em>T. pallidum</em> and HBV infections are the most frequent causes of donor ineligibility. The data indicate that prevalence rates remained relatively constant with minor fluctuations throughout the study period, although the frequency of HIV infection was notably higher in 2021.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 6","pages":"Article 104592"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.bjid.2025.104591
Kelliane Martins de Araujo , Marcos de Oliveira Cunha , Vivian Maria Cordeiro , Angélica de Lima das Chagas , José Daniel Gonçalves Vieira , Celia Regina Malveste Ito , Thais Reis Oliveira , Lucas Candido Gonçalves Barbosa , Isabela Wastowski Jubé , Lilian Carla Carneiro
Healthcare-associated infections are among the most significant complications in hospitalized patients, posing a major challenge due to the antimicrobial resistance of pathogenic agents such as Staphylococcus spp. The study aims to identify and evaluate the phenotypic and molecular resistance profile of Staphylococcus spp. in co-infection with respiratory viruses, including COVID-19, as a respiratory virus, in samples from children admitted to ICUs. Nasopharyngeal samples from the biorepository were stored at -80 °C in medium containing gentamicin and amphotericin B. Bacterial strains were isolated, and antibiograms were performed using the Kirby-Bauer method with antimicrobials specific to Staphylococcus spp. and the method of evaluating molecular resistance, carrying out the amplification of resistance genes, using specific oligonucleotides. A multidrug-resistant profile was observed in Staphylococcus spp., highlighting the need for monitoring to ensure appropriate treatment. Antimicrobial resistance emphasized the importance of strict control over antibiotic use in hospital environments. This study contributes to the understanding of antimicrobial resistance in bacterial co-infections, providing insights for more effective treatments and HAI control strategies.
{"title":"Identification and characterization of Staphylococcus spp. Isolated in co-infection with respiratory viruses from children in ICUs","authors":"Kelliane Martins de Araujo , Marcos de Oliveira Cunha , Vivian Maria Cordeiro , Angélica de Lima das Chagas , José Daniel Gonçalves Vieira , Celia Regina Malveste Ito , Thais Reis Oliveira , Lucas Candido Gonçalves Barbosa , Isabela Wastowski Jubé , Lilian Carla Carneiro","doi":"10.1016/j.bjid.2025.104591","DOIUrl":"10.1016/j.bjid.2025.104591","url":null,"abstract":"<div><div>Healthcare-associated infections are among the most significant complications in hospitalized patients, posing a major challenge due to the antimicrobial resistance of pathogenic agents such as <em>Staphylococcus</em> spp. The study aims to identify and evaluate the phenotypic and molecular resistance profile of <em>Staphylococcus</em> spp. in co-infection with respiratory viruses, including COVID-19, as a respiratory virus, in samples from children admitted to ICUs. Nasopharyngeal samples from the biorepository were stored at -80 °C in medium containing gentamicin and amphotericin B. Bacterial strains were isolated, and antibiograms were performed using the Kirby-Bauer method with antimicrobials specific to <em>Staphylococcus</em> spp. and the method of evaluating molecular resistance, carrying out the amplification of resistance genes, using specific oligonucleotides. A multidrug-resistant profile was observed in <em>Staphylococcus</em> spp., highlighting the need for monitoring to ensure appropriate treatment. Antimicrobial resistance emphasized the importance of strict control over antibiotic use in hospital environments. This study contributes to the understanding of antimicrobial resistance in bacterial co-infections, providing insights for more effective treatments and HAI control strategies.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 6","pages":"Article 104591"},"PeriodicalIF":2.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.bjid.2025.104589
Alexandre Prehn Zavascki , Alberto Chebabo , Clovis Arns Cunha , Alexandre Rodrigues Silva , Gabriel Trova Cuba , Daniel Wagner C.L. Santos , Ana Cristina Gales
Although international guidelines are available, a national consensus is crucial to address the unique challenges faced in Brazil regarding the management of infections caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). These challenges include marked regional disparities in antimicrobial access, variability in pathogen prevalence and resistance patterns, and unequal availability of diagnostic resources. This guideline, developed by a consensus of infectious diseases experts nominated by the Brazilian Society of Infectious Diseases, aims to support clinicians, particularly non-specialists, in the management of MDR-GNB infections across diverse healthcare settings in the country. The document focuses on pathogens classified as critical or high-priority by the World Health Organization (WHO), including Carbapenem-Resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA), ESBL- and AmpC-producing Enterobacterales, as well as Stenotrophomonas maltophilia, and Burkholderia cepacia. Therapeutic recommendations are organized by pathogen and infection site, including respiratory tract, skin and soft tissue, bloodstream, intra-abdominal, and both complicated and uncomplicated urinary tract infections.
{"title":"Guideline for antimicrobial treatment of multidrug-resistant Gram-negative infections: practice recommendations of the Brazilian Society of Infectious Diseases","authors":"Alexandre Prehn Zavascki , Alberto Chebabo , Clovis Arns Cunha , Alexandre Rodrigues Silva , Gabriel Trova Cuba , Daniel Wagner C.L. Santos , Ana Cristina Gales","doi":"10.1016/j.bjid.2025.104589","DOIUrl":"10.1016/j.bjid.2025.104589","url":null,"abstract":"<div><div>Although international guidelines are available, a national consensus is crucial to address the unique challenges faced in Brazil regarding the management of infections caused by multidrug-resistant Gram-negative bacilli (MDR-GNB). These challenges include marked regional disparities in antimicrobial access, variability in pathogen prevalence and resistance patterns, and unequal availability of diagnostic resources. This guideline, developed by a consensus of infectious diseases experts nominated by the Brazilian Society of Infectious Diseases, aims to support clinicians, particularly non-specialists, in the management of MDR-GNB infections across diverse healthcare settings in the country. The document focuses on pathogens classified as critical or high-priority by the World Health Organization (WHO), including Carbapenem-Resistant <em>Enterobacterales</em> (CRE), <em>Acinetobacter baumannii</em> (CRAB), and <em>Pseudomonas aeruginosa</em> (CRPA), ESBL- and AmpC-producing <em>Enterobacterales</em>, as well as <em>Stenotrophomonas maltophilia</em>, and <em>Burkholderia cepacia</em>. Therapeutic recommendations are organized by pathogen and infection site, including respiratory tract, skin and soft tissue, bloodstream, intra-abdominal, and both complicated and uncomplicated urinary tract infections.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 6","pages":"Article 104589"},"PeriodicalIF":2.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.bjid.2025.104590
José Wagner Leonel Tavares-Júnior , Francisco José Basílio , Francisco Edson Buhamra Abreu , Lucas Rodrigues Tomaz dos Santos , Pablo Picasso de Araújo Coimbra , Érico Antonio Gomes de Arruda
Prion diseases are significant contributors to rapidly progressive dementia. Among these conditions, sporadic Creutzfeldt-Jakob Disease (CJD) is the most prevalent, characterized by its rarity, lack of treatment options, and rapid progression to fatality. Diagnosis relies on a combination of clinical symptoms and specific alterations detected in brain MRI, EEG, and CSF analysis. The present study details the case of a 53-year-old individual from Fortaleza, Brazil, diagnosed with sporadic CJD, confirmed through clinical presentation and a series of diagnostic evaluations, including 14-3-3 protein detection and RT-QuIC analysis. Differential diagnoses were considered to rule out other rapidly progressing conditions, such as infectious and immune-related diseases, ultimately leading to a likely diagnosis of sporadic CJD.
{"title":"An unusual association between HIV and Creutzfeldt-Jakob disease in a patient from northeastern Brazil","authors":"José Wagner Leonel Tavares-Júnior , Francisco José Basílio , Francisco Edson Buhamra Abreu , Lucas Rodrigues Tomaz dos Santos , Pablo Picasso de Araújo Coimbra , Érico Antonio Gomes de Arruda","doi":"10.1016/j.bjid.2025.104590","DOIUrl":"10.1016/j.bjid.2025.104590","url":null,"abstract":"<div><div>Prion diseases are significant contributors to rapidly progressive dementia. Among these conditions, sporadic Creutzfeldt-Jakob Disease (CJD) is the most prevalent, characterized by its rarity, lack of treatment options, and rapid progression to fatality. Diagnosis relies on a combination of clinical symptoms and specific alterations detected in brain MRI, EEG, and CSF analysis. The present study details the case of a 53-year-old individual from Fortaleza, Brazil, diagnosed with sporadic CJD, confirmed through clinical presentation and a series of diagnostic evaluations, including 14-3-3 protein detection and RT-QuIC analysis. Differential diagnoses were considered to rule out other rapidly progressing conditions, such as infectious and immune-related diseases, ultimately leading to a likely diagnosis of sporadic CJD.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 6","pages":"Article 104590"},"PeriodicalIF":2.8,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nucleoside/nucleotide reverse transcriptase inhibitors, particularly tenofovir, can cause long-term side effects such as decreased bone mineral density and estimated glomerular filtration rate. A strategy to mitigate these effects is the simplification of antiretroviral therapy, which involves withdrawing one of the nucleoside/nucleotide reverse transcriptase inhibitors from the therapeutic scheme. While clinical trials and real-world studies have demonstrated that the simplified therapy maintains undetectable viral loads, its impact on bone mineral density and kidney function remains unclear owing to the lack of real-world evidence.
Methods
This retrospective cohort study compared 152 patients who underwent antiretroviral therapy simplification (primarily due to osteopenia, osteoporosis, or decreased estimated glomerular filtration rate) with 306 patients who maintained triple therapy, between April 2013 and September 2022. The simplified regimens included lamivudine plus dolutegravir or ritonavir-boosted darunavir. The groups were analyzed based on their demographic characteristics using Student's t-test in the case of symmetric data. Therapeutic success (undetectable viral load at the end of follow-up) was assessed using Kaplan Meier survival analysis. The estimated glomerular filtration rate variation before and after simplification was analyzed using the Mann-Whitney test. Pre-and post-simplification bone mineral density values were evaluated using the chi-square test for trends and assessed in the simplified therapy group. A significance level of 5% (α = 0.05) was adopted for all tests.
Results
Simplified antiretroviral therapy was non-inferior to triple therapy in maintaining undetectable viral load. Patients receiving simplified regimens showed a positive variation in estimated glomerular filtration rate. A small subset of patients also exhibited improvements in bone mineral density after antiretroviral therapy simplification.
Conclusions
These findings suggest that simplified therapy is as effective as triple therapy and has the additional benefit of reducing tenofovir-related adverse events.
{"title":"Effectiveness of simplifying antiretroviral therapy to maintain viral suppression and improve bone and renal health: comparing simplified and non-simplified therapy","authors":"Juliana Olsen Rodrigues, Alexandre Naime Barbosa, Stephanie Valentini Ferreira Proença, Lenice Rosário de Souza","doi":"10.1016/j.bjid.2025.104578","DOIUrl":"10.1016/j.bjid.2025.104578","url":null,"abstract":"<div><h3>Objective</h3><div>Nucleoside/nucleotide reverse transcriptase inhibitors, particularly tenofovir, can cause long-term side effects such as decreased bone mineral density and estimated glomerular filtration rate. A strategy to mitigate these effects is the simplification of antiretroviral therapy, which involves withdrawing one of the nucleoside/nucleotide reverse transcriptase inhibitors from the therapeutic scheme. While clinical trials and real-world studies have demonstrated that the simplified therapy maintains undetectable viral loads, its impact on bone mineral density and kidney function remains unclear owing to the lack of real-world evidence.</div></div><div><h3>Methods</h3><div>This retrospective cohort study compared 152 patients who underwent antiretroviral therapy simplification (primarily due to osteopenia, osteoporosis, or decreased estimated glomerular filtration rate) with 306 patients who maintained triple therapy, between April 2013 and September 2022. The simplified regimens included lamivudine plus dolutegravir or ritonavir-boosted darunavir. The groups were analyzed based on their demographic characteristics using Student's <em>t-</em>test in the case of symmetric data. Therapeutic success (undetectable viral load at the end of follow-up) was assessed using Kaplan Meier survival analysis. The estimated glomerular filtration rate variation before and after simplification was analyzed using the Mann-Whitney test. Pre-and post-simplification bone mineral density values were evaluated using the chi-square test for trends and assessed in the simplified therapy group. A significance level of 5% (α = 0.05) was adopted for all tests.</div></div><div><h3>Results</h3><div>Simplified antiretroviral therapy was non-inferior to triple therapy in maintaining undetectable viral load. Patients receiving simplified regimens showed a positive variation in estimated glomerular filtration rate. A small subset of patients also exhibited improvements in bone mineral density after antiretroviral therapy simplification.</div></div><div><h3>Conclusions</h3><div>These findings suggest that simplified therapy is as effective as triple therapy and has the additional benefit of reducing tenofovir-related adverse events.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 6","pages":"Article 104578"},"PeriodicalIF":2.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-19DOI: 10.1016/j.bjid.2025.104579
Patrick Leon de Godoy Macedo , Mariane Taborda , Vítor Falcão de Oliveira , Adriana Satie Gonçalves Kono Magri , Lígia Lins Frutuoso , Gideane Mendes de Oliveira , Sinaida T. Martins , Daniel Wagner de Castro Lima Santos , Fabianne Altruda de Moraes Costa Carlesse , Francelise Bridi Cavassin , Kelsen Dantas Eulálio , Marcia Lazera Andréa , Andréa d’Avila Freitas , José Ernesto Vidal , Dayvison Francis Saraiva Freitas , Marcia Garnica , Terezinha do Menino Jesus Silva Leitão , Rosely Maria Zancopé-Oliveira , Marcia de Souza Carvalho Melhem , Flavio Queiroz Telles , Marcello Mihailenko Chaves Magri
Background
Mucormycosis is a rare but life‑threatening fungal infection that has shown an increased incidence in Brazil, especially during the COVID‑19 pandemic.
Objective
To provide an evidence‑based, context‑specific guideline for the diagnosis and management of mucormycosis within the Brazilian healthcare system. Clinical features: Rhino‑orbito‑cerebral disease predominates, followed by pulmonary, cutaneous, gastrointestinal and disseminated forms; delayed recognition dramatically increases mortality.
Epidemiology
The global incidence of mucormycosis is increasing, particularly among patients with diabetes mellitus, hematologic malignancies, transplantation, and corticosteroid exposure. The most frequently isolated species is Rhizopus arrhizus, and regional variations in species distribution may be present. In Brazil, comprehensive epidemiological data remain scarce.
Treatment
Early, aggressive surgical debridement plus induction with liposomal amphotericin B (5–10 mg/kg/day) followed by isavuconazole or posaconazole is recommended; strict control of hyperglycemia and immunosuppression is essential.
Conclusion
Standardized national guidance, improved rapid diagnostics, systematic surveillance and equitable drug availability are critical to reduce Brazil’s mucormycosis burden.
{"title":"Brazilian task force for the management of mucormycosis","authors":"Patrick Leon de Godoy Macedo , Mariane Taborda , Vítor Falcão de Oliveira , Adriana Satie Gonçalves Kono Magri , Lígia Lins Frutuoso , Gideane Mendes de Oliveira , Sinaida T. Martins , Daniel Wagner de Castro Lima Santos , Fabianne Altruda de Moraes Costa Carlesse , Francelise Bridi Cavassin , Kelsen Dantas Eulálio , Marcia Lazera Andréa , Andréa d’Avila Freitas , José Ernesto Vidal , Dayvison Francis Saraiva Freitas , Marcia Garnica , Terezinha do Menino Jesus Silva Leitão , Rosely Maria Zancopé-Oliveira , Marcia de Souza Carvalho Melhem , Flavio Queiroz Telles , Marcello Mihailenko Chaves Magri","doi":"10.1016/j.bjid.2025.104579","DOIUrl":"10.1016/j.bjid.2025.104579","url":null,"abstract":"<div><h3>Background</h3><div>Mucormycosis is a rare but life‑threatening fungal infection that has shown an increased incidence in Brazil, especially during the COVID‑19 pandemic.</div></div><div><h3>Objective</h3><div>To provide an evidence‑based, context‑specific guideline for the diagnosis and management of mucormycosis within the Brazilian healthcare system. Clinical features: Rhino‑orbito‑cerebral disease predominates, followed by pulmonary, cutaneous, gastrointestinal and disseminated forms; delayed recognition dramatically increases mortality.</div></div><div><h3>Epidemiology</h3><div>The global incidence of mucormycosis is increasing, particularly among patients with diabetes mellitus, hematologic malignancies, transplantation, and corticosteroid exposure. The most frequently isolated species is Rhizopus arrhizus, and regional variations in species distribution may be present. In Brazil, comprehensive epidemiological data remain scarce.</div></div><div><h3>Treatment</h3><div>Early, aggressive surgical debridement plus induction with liposomal amphotericin B (5–10 mg/kg/day) followed by isavuconazole or posaconazole is recommended; strict control of hyperglycemia and immunosuppression is essential.</div></div><div><h3>Conclusion</h3><div>Standardized national guidance, improved rapid diagnostics, systematic surveillance and equitable drug availability are critical to reduce Brazil’s mucormycosis burden.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 6","pages":"Article 104579"},"PeriodicalIF":2.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-11DOI: 10.1016/j.bjid.2025.104576
Icaro Santos Oliveira , Carlos Augusto Finelli , Taiana Cunha Ribeiro , Carolina Coelho Cunha , Thomas Stravinskas Durigon , Rodrigo Peixoto Vargas , Rafael Brull Tuma , Giselle Burlamaqui Klautau , Fernando Baldy dos Reis , Mauro Jose Salles
Background
Fracture-Related Infection (FRI) is an increasing and challenging complication following orthopedic trauma surgery. Preventive and microbial diagnostic measures vary significantly particularly in low- and middle-income countries. The objectives of this national questionnaire were to investigate clinical practices towards preventive and diagnostic strategies adopted by Brazilian orthopedic trauma centers and to assess the impact of Multidisciplinary Teams (MDT) on the management of FRI.
Methods
A 34-item electronic questionnaire was developed via REDCap® and distributed to all trauma surgeons registered of the Brazilian Society of Orthopedics and Traumatology (SBOT).
Results
With a response rate of 24 %, the survey was fully responded by 140 trauma surgeons, 63.6 % of them working in southeast region centers. Collaborative work with MDT focused on musculoskeletal infections was reported by only 41.0 %. Cephalosporins were universally prescribed as Perioperative Antibiotic Prophylaxis (PAP), while association with an aminoglycoside increased (35.0 %) for severe open fracture. One-day duration of PAP for closed fracture was prescribed in 68.1 %, while it often exceeded current recommendations. Diagnostic practices for FRI patients were primarily based on clinical signs and standard radiological and laboratory tests, with limited use of microbiological techniques. Trauma services working collaboratively with MDT significantly improved FRI management, including, use of sonication fluid for diagnosis (46.6 % vs. 26.8 %; p = 0.02), body weight-adjusted antibiotic dosing for PAP (50.0 % vs. 24.4 %; p = 0.02), appropriate duration of PAP according to the severity of soft-tissue damage (80.7 % vs. 59.3 %; p = 0.01), infection risk stratification in elderly patients with fractures (45.6 % vs. 21.0 %; p < 0.001), use of negative-pressure wound therapy (87.9 % vs. 54.9 %; p < 0.001) and regular collaboration with orthoplastic surgeon (44.8 % vs. 17.5 %; p = 0.01).
Conclusions
This national survey revealed marked heterogeneity in FRI management across Brazilian trauma services. Ongoing MDT collaboration improved clinical practice, especially diagnostic work-up and antimicrobial stewardship.
{"title":"The impact of a multidisciplinary team on the management of fracture-related infections: A surveillance study in Brazil","authors":"Icaro Santos Oliveira , Carlos Augusto Finelli , Taiana Cunha Ribeiro , Carolina Coelho Cunha , Thomas Stravinskas Durigon , Rodrigo Peixoto Vargas , Rafael Brull Tuma , Giselle Burlamaqui Klautau , Fernando Baldy dos Reis , Mauro Jose Salles","doi":"10.1016/j.bjid.2025.104576","DOIUrl":"10.1016/j.bjid.2025.104576","url":null,"abstract":"<div><h3>Background</h3><div>Fracture-Related Infection (FRI) is an increasing and challenging complication following orthopedic trauma surgery. Preventive and microbial diagnostic measures vary significantly particularly in low- and middle-income countries. The objectives of this national questionnaire were to investigate clinical practices towards preventive and diagnostic strategies adopted by Brazilian orthopedic trauma centers and to assess the impact of Multidisciplinary Teams (MDT) on the management of FRI.</div></div><div><h3>Methods</h3><div>A 34-item electronic questionnaire was developed via REDCap® and distributed to all trauma surgeons registered of the Brazilian Society of Orthopedics and Traumatology (SBOT).</div></div><div><h3>Results</h3><div>With a response rate of 24 %, the survey was fully responded by 140 trauma surgeons, 63.6 % of them working in southeast region centers. Collaborative work with MDT focused on musculoskeletal infections was reported by only 41.0 %. Cephalosporins were universally prescribed as Perioperative Antibiotic Prophylaxis (PAP), while association with an aminoglycoside increased (35.0 %) for severe open fracture. One-day duration of PAP for closed fracture was prescribed in 68.1 %, while it often exceeded current recommendations. Diagnostic practices for FRI patients were primarily based on clinical signs and standard radiological and laboratory tests, with limited use of microbiological techniques. Trauma services working collaboratively with MDT significantly improved FRI management, including, use of sonication fluid for diagnosis (46.6 % vs. 26.8 %; <em>p</em> = 0.02), body weight-adjusted antibiotic dosing for PAP (50.0 % vs. 24.4 %; <em>p</em> = 0.02), appropriate duration of PAP according to the severity of soft-tissue damage (80.7 % vs. 59.3 %; <em>p</em> = 0.01), infection risk stratification in elderly patients with fractures (45.6 % vs. 21.0 %; <em>p</em> < 0.001), use of negative-pressure wound therapy (87.9 % vs. 54.9 %; <em>p</em> < 0.001) and regular collaboration with orthoplastic surgeon (44.8 % vs. 17.5 %; <em>p</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>This national survey revealed marked heterogeneity in FRI management across Brazilian trauma services. Ongoing MDT collaboration improved clinical practice, especially diagnostic work-up and antimicrobial stewardship.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 6","pages":"Article 104576"},"PeriodicalIF":2.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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